1

Integrative Review of the Literature

Katie Wyman

Bon Secours Memorial College of Nursing

NUR4322: Nursing Research

Dr. Turner

October 21, 2021

“I pledge…”
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Abstract

Purpose: The purpose of this integrative review was to look at the effect of a hospital nurses’ education

on their ability to complete wound care orders. Background: A nurse’s ability to complete wound care

on their patients safely and properly is an important ability because it can affect a patient’s health

outcomes and quality of care. Design/Search methods: The research design is an integrative review

based on three research articles that consisted of quantitative and qualitative articles. The search

database that was used was Ovid Medline. Results/Findings: The results indicated that education was

a major factor that affected a hospital nurses’ ability to complete wound care orders. Nurses who

participated in wound care education programs or were wound care certified were more knowledgeable

about wound care. The results also showed that simulated scenarios can be used as an effective

education and assessment tool for nurses. Limitations: Some limitations included small number of

participants, lack of geographically diverse sample, lack of a review board, and exclusion of discussion of

the reliability or validity of collection methods. Implications: Implications for practice include using

simulation to educate and assess a nurse’s knowledge on wound care and encouraging nurses to

participate in wound care education programs. Recommendations for future research: Future research

topics could be to develop multiple simulations for different types of wounds and to also dive into the

education aspect of wound care treatment/prevention.

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Integrative Review of the Literature

The purpose of this integrative review is to examine the education of hospital nurses and how it

affects their ability to complete wound care orders. Wound care is an important skill that nurses must

possess and master. Yet, “Previous studies have found both registered nurses' and student nurses'

wound care competence to be limited” Kielo-Vijamaa et al., 2021). This is therefore putting patients’

quality of life and their quality of care at risk. Although multiple studies have shown that moisture

retentive dressings are associated with faster healing, less infection, improved patient comfort, less

scarring, and reduced care costs; about 50% of wounds are still being covered with gauze which means

that patients are receiving non-evidence-based practice. (Rijswijk, 2019). This topic is important

because nurses are often the first healthcare providers to view wounds. Although many hospitals have

wound care teams on staff, there are barriers to access. Most wound-care team members workday shift,

which means that night shift does not benefit from their services. On day shift, the wound care teams

often see high patient volumes, making it difficult to see all of the patients they are responsible for.

Because of these reasons it is key that nurses can assess wounds properly, choose an appropriate

dressing, and complete wound care orders that are placed. The aim of this integrative review is to

discuss and analyze research studies related to the PICOT question: In hospital nurses(P), what is the

effect of education(I) on their ability to complete wound care orders(O)?

Design and Search Method

The research design is an integrative review. The search engine used was Ovid, more specifically

Ovid Medline. The search terms included “wound care”, “nurses”, “nursing”. “knowledge”, “wound

healing”, “healthcare professionals”, “wound management”, and “experience”. Several searches were

conducted using a mixture of the above search terms. When the terms “wound care and nurses” along

with filters ‘last five years’ and ‘full text’ were used, it generated 3,596 results. When the terms “wound
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care and nurses” were used with filters ‘full text article’ and ‘since year 2006’, 15,000 results were

produced. Finally, when the terms “wound management, nurse, knowledge, and experience” were used

in combination with the filters ‘last five years’ and ‘full text’, there were 1,005 results.

The articles had to pertain to the PICOT question: “In hospital nurses, what is the effect of

education on their ability to complete wound care?” The articles were then selected based on the

inclusion criteria of registered nurses, wound care, educational tool used to evaluate, knowledge

regarding wound care, and dressing type. Exclusion criteria included articles that specifically spoke only

about doctors or nursing students. If studies did not relate to PICOT question or inclusion criteria, then

they were excluded. A total of three articles are used in this integrative review, including 2 quantitative

studies (Rijswijk, 2019; Zarchi et al., 2014) and 1 qualitative study (Kielo-Vijamaa et al., 2021).

Findings/Results

The findings and results of the three studies showed that nurses are key factors when

implementing wound care into a patient’s care. Education and simulated tools play a huge part on

quality wound care. The summary of the literature tables can be seen in Appendix 1, which describes

each article in detail. The researcher pulled two common themes between the three articles which

consist of experience with wound care education programs and simulated scenarios.

Experience with wound care education programs

Two of the studies present in this review showed that experience with wound care education

programs is a key factor in a nurse’s ability to complete wound care orders properly (Zarchi et al., 2014;

Rijswijk, 2019). These two studies found that more education and experience in wound care education

programs showed a higher knowledge in wound care than those who did not have experience with

wound care education programs.

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The aim of the cross-sectional study completed in Denmark by Zarchi et al. (2014), was to

identify the knowledge of wound management in different settings which consisted of home health

nurses and hospital nurses. The researchers also obtained additional information about workplace,

experience level, and previous attendance at wound care educational programs (Zarchi et al, 2014).

Zarchi et al. (2014), obtained 134 nurses, which consisted of 64 home health nurses and 57 hospital

nurses spanning across 8 different clinical settings. These participants were obtained through the

hospital system and were told to complete the 26-item questionnaire whenever they had the time to

complete it in one sitting. The questionnaire consisted of 3 types of questions: basic

knowledge/symptoms identification, investigation, and treatment all of which were dependent variables

(Zarchi et al., 2014). A Kruskal Wallis test was used to analyze overall difference in the number of

correct answers between questions and a Wilcoxon rank sum test used for pairwise comparison across

the groups (Zarchi et al., 2014). The findings from Zarchi et al. (2014) showed that the category of

treatment (78) had the highest number of correct answers followed by basic knowledge/symptoms

identification (76) and then investigation (59). There was a statistically significant difference between

the three categories. Out of the three types of nurses, wound care clinic nurses, hospital nurses, and

home health nurses, wound care clinic nurses scored higher in all categories, and this was statistically

significant. Experience levels were not statistically significant when looking at the number of right vs

wrong answers. Attending educational programs had a statistical significance when compared to the

results. Workplace was the most important predictor in results, indicating that if you worked in a

wound care clinic it led it an increase of 26% of correct answers. Working in home health led to higher

test results than working in a hospital setting. Although wound care is considered a part of everyday

practice in hospital setting, hospital nurses scored the lowest indicating that it may be better for patients

suffering from chronic wounds to receive specialized care outside of the hospital. Although nurses were

shown to have a high level of knowledge about therapeutics/treatment, the lower scores in the
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investigation categories may lead nurses to report insignificant or incorrect findings to doctors who

therefore diagnosis incorrectly leading to the incorrect treatment (Zarchi et al., 2014).

The aim of Rijswijk (2019), quantitative descriptive study was to evaluate a validated online

wound care assessment tool regarding would care and RN’s by assessing the ease of use of the online

tool, looking at the percentages of right and wrong answers, and comparing the choices of wound care

dressings between certified wound care RN’s and non-certified RN’s. This study was completed on the

East Coast of the United States and consisted of 418 registered nurses of which 293 were not certified in

wound care, 189 held bachelor’s degree, 277 worked in an inpatient setting (Rijswijk, 2019). Rijswijk

(2019), study used a computer assisted wound assessment and care educational program which showed

participants 15 pictures with moisture descriptions where they had to complete an algorithm and select

the appropriate dressing. After completing the computer program, nurses were then prompted to take

a questionnaire that asked about the ease of use of the program, ability to incorporate the wound care

knowledge gained into practice, and the educational value of the online program (Rijswijk, 2019).

Rijswijk (2019) used a 2-sample student t-test and a paired t-test used to compare first 6 wounds to last

6 wounds when looking at number of right, partially right (safe but wrong), and wrong answers, wound

certified vs not certified RN correct dressing selections, correct dressing choices, and correct assessment

of wound. The findings presented by Rijswijk (2019), showed that the mean proportion of fully correct

answers were 71%. The mean proportion of partially correct choices were 81%. Wound care nurses had

a higher percentage of correct answers and correct dressing choices than nurses who were not wound

care certified. Incorrect assessment of necrotic tissue accounted for the most incorrect and partially

correct answer choices. The number of correct algorithm selections for the first 6 wounds was 74% right

and the last 6 were 81% correct. Although only 24% of participants completed the survey about the

ease of use and clinical application of the program, ease of use was rated a 4.22 out of 5 scale and

educational applicability and value was rated a 4.22 and 4.19 out of 5 scale. It was also discovered that
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nurses selected a safe evidence-based practice dressing selection 75% of the time. It was also shown to

be statistically significant that participant learning occurred while using the online program which

indicates that computer-based learning can be used as an education tool (Rijswijk, 2019).

Simulated Scenarios

Two of the three studies showed that a type of simulation helped educate and assess a nurse’s

knowledge and ability to complete wound care orders (Kielo-Vijamaa et al., 2021; Rijswijk, 2014).

Simulated scenarios can either be defined as having nurses assess pictures/words or it can be having an

actor/mannequin who is assessed and treated as a patient.

Kielo-Vijamaa et al. (2021), conducted a qualitative, descriptive, methodologic design with the

purpose of the study “to describe the development and use of the wound care simulation in assessing

registered nurses’ and graduating student nurses’ practical wound care competence; (2) to describe

observations of participants' wound care competence”. The study was conducted in Finland and

consisted of 50 participants,19 student nurses, 20 registered nurses, 6 student podiatrists, 5 podiatrists;

student nurses were pulled from one Finnish bachelors program school and registered nurses were

taken from 2 hospitals representing primary specialized health care units with the study being

conducted either at the employees’ place of work or the student’s simulation lab (Kielo-Vijamaa et al.,

2021). Kielo-Vijamaa et al. (2021), used a simulated anatomic wound model and had participants come

in and evaluate and treat the wound with the tools that researchers had set up for them. A registered

nurse, wound care researchers, a podiatrist, a vascular surgeon, and a plastic surgeon with specialization

in wound care evaluated the student or nurses’ evaluation of the wound using a 14-item objective list

that contained pain assessment, procedure preparation, aseptic technique and procedure, pain

management, tissue type and color identification, identifying signs of infection, debridement, bacteria

sampling, use and function of wound care products, diabetic foot ulcer care, documenting the
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description of the wound, documenting care, motivation and self-care, consultation, and other

observations (Kielo-Vijamaa et al., 2021). Participants were recorded and evaluators then went back

and evaluated them with the items listed above which they then discussed afterwards between each

other and gave each participants a total score once they reached a consensus (Kielo-Vijamaa et al.,

2021). The results from the study by Kielo-Vijamaa et al. (2021) showed that only two thirds assessed

the patient’s pain before starting wound care and just over one half adequately managed the pain

before starting wound care. Only one third demonstrated proper aseptic technique, less than one third

of participants took a bacteria sample properly, and only half understood the importance of offloading.

Documentation of the wound and the wound care was insufficient. When looking at each objective that

the participants were graded on during pain assessments two thirds asked about pain before wound

care. During procedure preparation twenty five individuals thought about what equipment they would

need and moved it closer before starting wound care. During aseptic technique and procedure only 17

participants performed proper asepsis using clean technique. Looking at pain management twenty-

eight individuals administered local anesthesia to ease pain before debridement. When looking at tissue

type and color identification forty-nine identified yellow fibrin slough and five also identified a joint.

When Identifying signs of infection thirty-nine identified a possible wound infection, twenty-three

highlighted the smell, and sixteen highlighted the redness. When debriding forty-eight demonstrated

wound debridement. Looking at Bacteria sampling, twenty-seven took a bacteria sampling from the

wound of the bed using swabs but only fifteen completed the sampling correctly which is after

debridement. Evaluating use and function of wound care products forty-five participants chose the

correct wound dressing for in wound but eleven did not understand the function of the products they

chose. Thirty chose a hydrophobic dressing, seventeen silver, and six medical honey. Forty-eight chose

a foam dressing to cover the wound, only one remembered to date the dressing and one asked if patient

was allergic to any products. When looking at the category diabetic foot ulcer care, twenty-eight
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participants understood the purpose of offloading, twenty-five wound of changed footwear so the

wound was not chaffing. When evaluating documenting the description of the wound, twenty-six

described the wound comprehensively which means they described at least three of the following: size,

tissue type/color, exudate, and signs of infection. Twenty-two measured the size with a ruler. When

documenting care, eighteen documented the wound care comprehensively. In the category of

motivation and self-care, eighteen discussed the importance of proper footwear. In the category of

consultation, forty-three would have consulted a physician about the necrotic tissue and suspicion of

insufficient arterial circulation and wound infection (Kielo-Vijamaa et al., 2021).

Discussion and Implications for Practice

The three research articles highlight important findings that suggest that education affects a

hospital nurses’ ability to complete wound care orders. All articles discuss and agree that nurse’s

knowledge on wound care is crucial to quality patient care (Kielo-Vijamaa et al., 2021; Rijswijk, 2019;

Zarchi et al., 2019). The authors of the three studies discuss and provide support relating to the PICOT

question: In hospital nurses, what is the effect of education on their ability to complete wound care

orders? All three studies (Kielo-Vijamaa et al., 2021; Rijswijk, 2019; Zarchi et al., 2019) investigated and

tested nurses on their knowledge of appropriate treatment/dressing choice. Rijswijk (2019) and Kielo-

Vijamaa et al. (2021), used a form of simulation to test nurses’ knowledge in wound care. Some

differences include the type of research designs the studies consisted of. Two of the studies were

quantitative (Rijswijk, 2019; Zarchi et al., 2014) while the other was a qualitative cross-sectional study by

Kielo-Vijamaa et al. (2021).

Some implications for these findings support the fact that simulations can be used to educate

and assess a nurse’s knowledge on caring for wounds and choosing correct dressings. These studies also

show that nurses educated in wound care or attend wound care education programs are more equipped
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to handle the treatment of wounds. An implication to this finding would be to refer clients with serious

wounds to specialists so that they can receive the proper quality wound care treatment that they may

need. Another implication would be to hire more wound care nurses to cover the sheer amount of

wound care that the hospital encounter along with hiring a wound care nurse at night to deal with

possible complicated dressing changes or assessments of wound upon new admissions. It would also be

important to encourage nurses to seek out additional education experiences regarding wound care to

broaden their knowledge. Some future research topics could be to develop multiple simulations for

different types of wounds and to also dive into the education aspect of wound care

treatment/prevention.

Limitations

The articles in this literature review have some limitations that could hinder the research that

they collected. The study by Rijswijk (2019), only included nurses from the Northeast of the United

States therefore this information cannot be generalized to other nurses worldwide. The study by Kielo-

Vijamaa et al. (2021), only consisted of 50 participants, of those 50 participants only 20 consisted of

registered nurses, which is a small number for a study and the results may not be able to be generalized

to the population. In the study by Zarchi et al. (2014), there was no review board that was mentioned in

the study to approve the research. This can be a red flag because a review board is important to ensure

that the study is ethical and safe regarding the participants. The Zarchi et al. (2014) study also did not

discuss the reliability or validity of the instruments used to collect the data.

Value to Practice

To conclude, education and simulated scenarios were the two major themes found in these

articles (Kielo-Vijamaa et al., 2021; Rijswijk, 2019; Zarchi et al., 2014). The theme education showed that

individuals with wound care certification or those that participated in wound care education programs
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were more equipped and educated to deal with wound care treatment, dressing changes, and general

knowledge. The theme simulated scenario showed that simulations educate and assess a nurse’s

knowledge on wound care. These simulated scenarios imitated life like situations which can make

nurses feel like they are taking care of a real patient. These relate to the PICOT question: In hospital

nurses, what is the effect of education on their ability to complete wound care orders because they are

talking about the type of education nurses received and the impact it has on a nurse’s ability to

complete wound care orders and the impact that new education technologies can have on a nurse’s

ability to complete wound care orders.

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References

Kielo-Vijamaa, E., Ahtiala, M., Stolt, M., & Suhonen, R. (2021, November). Simulated wound care as a

competence assessment method for student and registered nurses. Advances in Skin and

Wound Care, 34, 1-9. http://doi 0.1097/01.ASW.0000756676.32202.b1.

Rijswijk, L. (2019). Computer-assisted wound assessment and care education program in registered

nurses: Use of an interactive online program by 418 nurses. Journal of Wound Ostomy and

Continence Nursing, 46(2), 90-97. http://doi 0.1097/WON.0000000000000515.

Zarchi, K., Latif, S., Haugaard, V, Hijalager, I., & Jemec, G. (2014). Significant differences in nurses’

knowledge of basic wound management-Implications for treatment. Acta Derm Venerol, 94,

403-407. http://doi 10.2340/00015555-1770. PMID: 24352474.

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Appendix

APA Citation / Kielo-Vijamaa, E., Ahtiala, M., Stolt, M., & Suhonen, R. (2021,
Author
Qualifications November). Simulated wound care as a competence assessment

method for student and registered nurses. Advances in Skin and

Wound Care, 34, 1-9. http://doi

0.1097/01.ASW.0000756676.32202.b1.

All the authors are registered nurses with some being wound care
nurses, some have PhD’s and one being a director of nursing.
Background/ The background talks about how simulation learning is an effective tool
Problem for teaching nursing students and training nurses. It also talks about
Statement how simulations are excellent evaluation tools for licensing and
credentialing professionals. It then goes into the lack of studies
regarding simulations and wound care. Previous studies have been
focused on measuring students’ knowledge and attitudes towards
wound care, specifically, knowledge tests on diabetic foot ulcers,
pressure ulcers, and leg ulcers, and not competence like skills and
performance. The authors talk about the importance of wound care
knowledge is because it can improve patient safety and quality of care.
Competence self-assessments are not a good indicator of knowledge
about wound care because people tend to overestimate their
competence. The question that was researched was what kind of
observations can be made from registered nurses and student nurses
wound care competence in the simulated situation. The goals of this
were to provide new knowledge of registered nurses' and student nurses'
wound care competence and to provide knowledge of simulation as a
competence assessment method that could be used in undergraduate and
continuing nursing education

Conceptual or N/A
Theoretical
Framework

Research This research design is described as a qualitative descriptive

Design (i.e. methodologic design.
qualitative,
quantitative) /
Specific Design
(i.e.
Phenomenology
, Experimental) /
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Philosophical
Underpinnings
(for qualitative
designs only)

Sample (size, 50 participants-19 student nurses, 20 registered nurses, 6 student

type, sampling podiatrists, 5 podiatrists
method) / Student nurses were pulled from one Finnish bachelors program school,
Geographical registered nurses were taken from 2 hospitals representing primary
location/ specialized health care units
Setting/ Finland was where the study was
Ethical Study was either done in the simulation lab in the student’s school or at
Considerations the registered nurses place of work
Study was adhered to by the European Code of Conduct for Research
Integrity and permission was received by the ethics boards at all places
where the study was being conducted
Type of Data Had a simulated patient with a wound and registered nurse, wound care
Collected researchers, a podiatrist, a vascular surgeon, and a plastic surgeon with
(Major Variables specialization in wound care evaluated the student or nurses’ evaluation
Studied- of the wound using a 14-item objective list that contained
independent, Pain assessment, procedure preparation, aseptic technique and
dependent and procedure, pain management, tissue type and color identification,
their definitions), identifying signs of infection, debridement, bacteria sampling, use and
if appropriate function of wound care products, diabetic foot ulcer care, documenting
the description of the wound, documenting care, motivation and self-
care, consultation, and other observations. All of these were dependent
variables
Independent variables included the competence of each individual and
the simulation
Measurement Measurement tools included the questionnaire that the evaluators used
Tools/ Method Also used video to record each of the participant’s
of Data
Collection (i.e.
BP cuff, Visual
analog scale,
Beck
Depression
Index)

Data Analysis Theoretical competence and attitude assessments

(ex. Statistical Qualitative observational annotations independently
tests used or Evaluators then got together to discuss their observations and possible
Content/Thematic discrepancies
analysis. NOT If there was a disagreement whether an item on the list was completed it
software [i.e. was recorded as “no consensus between the researchers”
NUD*st or SPSS
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or SAS])

Findings (i.e. Pain assessments-2/3 asked about pain before wound care, 3 asked
statistically about pain during caring process and 1 asked about pain after local
significant or anesthesia, 4 asked about pain after starting wound care and one person
descriptive or did not think the wound would be painful
themes) / Procedure preperation-25 of the participants thought about what
Discussion equipment they would need and gathered it closer before starting
wound care.
Aseptic technique and procedure-Only 17 participants performed
proper asepsis using clean technique. 49 wore medical gloves when
examining and 45 cleaned hands before beginning. 21 wore a face
mask and 25 wore a gown which is the recommended practice in
Finland
Pain Management-28 individuals administered local anesthesia to ease
pain before debridement
Tissue type and color identification-49 participants identified yellow
fibrin slough and five also identified a joint
Identifying signs of infection-39 identified a possible wound infection,
23 highlighted the smell, 16 highlighted the redness
Debridment-48 demonstrated wound debridement, 44 used curette to
remove fibrin covering from wound bed, 20 used gel or solution to
soften before debridement
Bacteria sampling-27 took a bacteria sampling from the wound of the
bed using swabs but only 15 completed the sampling correctly which is
after debridement
Use and function of wound care products-45 participants chose the
correct wound dressing for in wound but 11 did not understand the
function of the products they chose. 30 chose a hydrophobic dressing,
17 silver, and 6 medical honey, 48 also chose a foam dressing to cover
the wound, only one remembered to date the dressing and one asked if
patient was allergic to any products
Diabetic foot ulcer care-28 participants understood the purpose of
offloading, 2g5 wound of changed footwear so the wound was not
chaffing
Documenting the description of the wound-26 described the wound
comprehensively which means they described at least 3 of the
following: size, tissue type/color, exudate, and signs of infection. 22
measured the size with a ruler
Documenting care-18 documented the wound care comprehensively
meaning they documented at least 3 of the following:
cleaning/debridement, bacteria sampling, used products/dressing, and
patient education
Motivation and self-care-23 educated or motivated the patient, 18
discussed the importance of proper footwear, 8 discussed wound care
and 3 talked about nutrition and blood sugar monitoring
Consultation-43 would have consulted a physician about the necrotic
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tissue and suspicion of insufficient arterial circulation and wound

infection, 5 said they would have sent the patient to the ER, 7 would
have consulted a podiatrist,
Other observations-12 participants would have assessed the patient’s
peripheral circulation

To conclude only two thirds assessed the patient’s pain before starting
wound care and just over one half adequately managed the pain before
starting wound care and they were told that the wound was painful
before starting. Only 1/3 demonstrated proper aseptic technique, less
than 1/3 of participants took a bacteria sample properly, and only half
understood the importance of offloading. Documentation of wound and
the wound care was insufficient.
Appraisal/ This is valuable to the PICOT question because it is showing that this
Value to type of simulation was an adequate way to show competence in wound
Practice based care. It covered 14 different important aspects of wound care that
on PICOT should be completed when assessing a wound. If the nurse can
Question adequately identify and complete the 14 tasks, then their wound care
knowledge and competence can be deemed adequate. If it is not, then
this can be used as an education tool to teach nurses about areas where
they may be lacking.

APA Citation / Rijswijk, L. (2019). Computer-assisted wound assessment and care

Author
Qualifications education program in registered nurses: Use of an interactive

online program by 418 nurses. Journal of Wound Ostomy and

Continence Nursing, 46(2), 90-97. http://doi

0.1097/WON.0000000000000515.

author is a Doctor of Nursing practice, a registered nurse, and a

certified wound care nurse which makes her qualified.
Background/ Some background on the topic of wound care and knowledge is
Problem the importance that the author presents regarding that nurse’s
Statement should have adequate knowledge about wound care and the
dressing types. The author further goes onto say that the
knowledge that new grads have is insufficient regarding wound
care and that nurses are hesitant or there are barriers present
that prevent them from implementing evidence-based practice.
The author further goes onto say that online learning can help in
reaching millions of nurses but there are few studies that look at
the effectiveness of online learning modules. The authors aim of
the study is to evaluate a validated online wound care
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assessment tool regarding would care and RN’s by assessing

the ease of use of the online tool, looking at the percentages of
right and wrong answers, and comparing certified wound care
RN’s dressing types to non-certified RN’s.

Conceptual or N/A
Theoretical
Framework

Research -quantitative descriptive study

Design (i.e.,
qualitative,
quantitative) /
Specific Design
(i.e.,
Phenomenology
, Experimental) /
Philosophical
Underpinnings
(for qualitative
designs only)

Sample (size, -418 RN’s

type, sampling -average age 46
method) / 368 females
Geographical 293 not certified in wound care
location/ 189 held bachelor’s degree
Setting/ 277 worked in an inpatient setting
Ethical RNs had to verify that they held licensure
Considerations Throughout the United States
Could be completed from an online forum anywh6ere
Consulted an IRB board from La Salle and West Chester
university
Type of Data Number of right, partially right (safe but wrong), and wrong
Collected answers=dependent
(Major Variables Wound certified vs not certified RN correct dressing selections
Studied- Correct dressing choices
independent, Correct assessment of wound
dependent and Ease of use of program
their definitions), Ability to incorporate the wound care knowledge gained into
if appropriate practice
Educational value of the online program
Nurses’ knowledge=independent

Measurement Demographic and practice setting questionnaire

Tools/ Method Computer program th6at calculated right, partially right, and
of Data wrong answer
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Collection (i.e., Survey that asked about ease of use of program, ease of use
BP cuff, Visual regarding the algorithm, educational value, and applicability
analog scale,
Beck
Depression
Index)

Data Analysis 2 sample student t-test

(ex. Statistical Dressing choices and individual algorithm coded by program
tests used or Paired t-test used to compare first 6 wounds to last 6 wounds
Content/Thematic
analysis. NOT
software [i.e.,
NUD*st or SPSS
or SAS])

Findings (i.e., The mean proportion of fully correct answers were 71%. The
statistically mean proportion of partially correct choices were 81%. Wound
significant, or care nurses had a higher percentage of correct answers and
descriptive or correct dressing choices than nurses who were not wound care
themes) / certified. Incorrect assessment of necrotic tissue accounted for
Discussion the most incorrect and partially correct answer choices. The
number of correct algorithm selections for the first 6 wounds was
74% right and the last 6 were 81% correct. Although only 24% of
participants completed the survey about the ease of use and
clinical application of the program, ease of use was rated a 4.22
out of 5 scale and educational applicability and value was rated a
4.22 and 4.19 out of 5 scale. It was also discovered that nurses
selected a safe evidence-based practice dressing selection 75%
of the time. It was also shown to be statistically significant that
participant learning occurred while using the online program
which indicates that computer-based learning can be used as an
education tool.

Appraisal/ This is of value to the PICOT question because it is showing that

Value to an online program regarding wound care showed an
Practice based improvement in learning. This study also showed that hospital
on PICOT nurses that are not wound care certified are less likely to choose
Question correct dressings for wounds and assess the wound properly.
This is possibly indicating that the education of wound care in
nursing schools is lacking and therefore can hurt patient care.
APA Citation / Zarchi, K., Latif, S., Haugaard, V, Hijalager, I., & Jemec, G. (2014).
Author
Qualifications Significant differences in nurses’ knowledge of basic wound
 19

management-Implications for treatment. Acta Derm Venerol,

94, 403-407. http://doi 10.2340/00015555-1770. PMID:

24352474.

I do not have enough information to determine if the authors have

enough background or experiences. It seems that the main author
works in dermatology.
Background/ The study goes into talking about the background of wounds and
Problem how they are an ancient problem. With the population getting
Statement older and lifestyle disease are increasing wound care is going to
become more prevalent. Nurses are key providers when it
comes to wound care and doctors depend heavily on the opinion,
guidance, and evaluation of nurses. The quality of the wound
management depends on the nurse’s knowledge. The
hypothesis states that the knowledge is influenced by nurse
knowledge and practice of wound care. This study aimed to
investigate the level of knowledge of wound management in
Danish nurses in different setting types.

Conceptual or N/A
Theoretical
Framework

Research Cross sectional study

Design (i.e.
qualitative,
quantitative) /
Specific Design
(i.e.
Phenomenology
, Experimental) /
Philosophical
Underpinnings
(for qualitative
designs only)

Sample (size,  134 nurses (64 home health nurses, 57 hospital nurses
type, sampling representing 8 clinical settings
method) /  15 worked in advanced clinical wound care settings
Geographical  Location was in Denmark
location/  They completed a 26-item questionnaire in one sitting
Setting/ whenever their employer arranged a meeting
Ethical  Study does not mention a review board
Considerations
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Type of Data Length of time qualified as a nurse=independent

Collected Hospital nurses and home health nurses=independent
(Major Variables Participation/certification in wound care programs/courses
Studied- Types of wound care question categories
independent, -Basic knowledge/symptom identification=dependent
dependent and -Investigation=dependent
their definitions), -Treatment=dependent
if appropriate Right vs wrong answers=dependent

Measurement 26-item questionnaire

Tools/ Method
of Data
Collection (i.e.
BP cuff, Visual
analog scale,
Beck
Depression
Index)

Data Analysis Kruskal Wallis test used to analyze overall difference in the
(ex. Statistical number of correct answers between questions
tests used or Wilcoxon rank sum test used for pairwise comparison across the
Content/Thematic groups
analysis. NOT
software [i.e.
NUD*st or SPSS
or SAS])

Findings (i.e. The category of treatment (78) had the highest number of correct
statistically answers followed by basic knowledge/symptoms identification
significant or (76) and then investigation (59). There was a statistically
descriptive or significant difference between the three categories. Out of the
themes) / three types of nurses, wound care clinic nurses, hospital nurses,
Discussion and home health nurses, wound care clinic nurses scored higher
in all categories, and this was statistically significant. Experience
levels were not statistically significant when looking at the
number of right vs wrong answers. Attending educational
programs had a statistical significance when compared to the
results. Workplace was the most important predictor in results,
indicating that if you worked in a wound care clinic it led it an
increase of 26%. Working in home health led to higher test
results than working in a hospital setting. Although wound care
is considered a part of everyday practice in hospital setting these
nurses scored the lowest indicating that it may be better for
patients suffering from chronic wounds to receive specialized
care outside of the hospital. Although nurses were shown to
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have a high level of knowledge about therapeutics/treatment, the

lower scores in the investigation categories may lead nurses to
report insignificant or incorrect findings to doctors who therefore
diagnosis incorrectly leading to the incorrect treatment.

Appraisal/ This is of value to the PICOT question because it shows that

Value to wound care clinic nurses have the highest education level in
Practice based wound competence while hospital nurses have the lowest
on PICOT knowledge in wound competence even though hospital nurses
Question are expected to perform wound care as a daily part of the job.
Number of years of experience had no influence on correct
answer/knowledge while workplace and educational programs
had a bigger influence on wound competence.